Complementary and alternative therapies
Many patients look to ‘more natural’ herbal and alternative treatments. There are limited data on the efficacy and safety of such products, and the specific ingredients, their concentrations and production processes are not well regulated. These alternative therapies include tea tree oil, niacinamide, ayurvedic compounds, antioxidant agents, zinc, probiotic treatments and many types of naturally occurring oils. Dietary modification, biofeedback-assisted relaxation, cognitive imagery and acupuncture have also been tried as alternative therapies to treat acne.
We must remember that patients will often seek treatment advice from non-medical sources and that even when seen by their own doctor, they may not adhere to the medication or attend follow-up appointments. The initial consultation should aim to establish trust between GP and patient and to emphasise the importance of review to see if treatment is working.
New therapies for acne continue to be developed. Last year, a new fixed dose combination for acne treatment was launched (1% clindamycin phosphate/tretinoin 0.025%), and this year trifarotene 0.005%, a new type of retinoid cream, will likely be available to treat both facial and truncal acne. The newest agents include minocycline foam (currently available in the US) and a topical androgen clascoterone.29,30 These new treatments are not available in Australia at the time of writing.
The role of cannabinoid signalling in skin maintenance and regeneration has prompted investigation of cannabinoids as potential therapeutic targets in acne treatment and includes the topical agent BTX1503, which demonstrated mixed results in a recent phase 2 clinical trial.31,32
Many of these therapies are in various stages of testing, and show promise for future treatments.
Patients with acne need to be assessed for severity of disease as well as for its psychological impact. Listening to patients’ concerns and individualising treatment will help to strengthen the doctor–patient relationship. In a world of ‘fake news’ and so-called experts, healthcare professionals need to rely on their medical expertise and scientific background to offer patients effective treatment. MT